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A normal arterial blood gas in a gravid woman is a pH of 7.40 to 7.47, with a Paco2 of 30 to 32 mm Hg and a normal to slightly elevated Pao2. 3.7 Minor Disorders of Pregnancy 57 3.8 Diagnosis of Pregnancy 60 3.9 Antenatal Care 62 3.9.1. Period following childbirth Pelvic organs & other body tissues Revert to pre-pregnant state Anatomically & physiologically 3. Expected Changes of Pregnancy Because pregnancy is a normal process, a pregnant woman is typically able to manage most . A multiple pregnancy involves more than one offspring, such as with twins. The mean, median, and mode are equal. Labour and childbirth The first weeks with your new baby. 1 Chromosomes, Karyotyping, and Abnormalities (Learning Objectives) • Learn the components and parts of a metaphase chromosome. normal serum testosterone. • These codes should not be used in conjunction with chapter 15 codes. Period following childbirth Pelvic organs & other body tissues Revert to pre-pregnant state Anatomically & physiologically 3. Complications of pregnancy may include high blood pressure of pregnancy, gestational diabetes, iron-deficiency anemia, and hyperemesis gravidarum [2]. SUMMARY Human chorionic gonadotropin is a glycoprotein hormone produced by the developing placenta shortly after fertilization. Colposcopic impression: Normal/Benign Findings Low Grade High Grade Cancer Other findings: _____ Cervical biopsies obtained (Note: 2 or more biopsies increase the sensitivity of colposcopy): week until delivery or. Normality of these events would . b. Antepartum care is initiated less than three months before delivery, or It'll help you prepare for word "baby" to your pregnancy and your new baby. Pregnancy, also known as gestation, is the time during which one or more offspring develops inside a woman. A urinalysis requires 3 types of examination: • Direct observation to note color, odor, and consistency. Immediately after delivery, the uterus weighs approximately 1 kg, and its size approximates that of a 20-week pregnancy (at the level of the umbilicus). Before pregnancy, the uterus weighs 100g, and at term it weighs 1100g. More specifically, labor requires regular, effective contractions that lead to dilation and effacement of the cervix. This usually continues throughout the Pregnancy Book Your complete guide to: A healthy pregnancy. History Taking 64 3.9.2 Examination of the Pregnant Woman At First Visit 65 3.9.3 Laboratory test 74 Review Questions 76 CHAPTER FOUR: NORMAL LABOUR 77 4.1 Mechanism and Stages of Labour 79 4.1.1 Management of 1st Stage of Labour 79 NORMAL PUERPERIUM 2. increased need for iron in pregnancy and unlikely to be resolved without treatment. Note: Creation of this catalogue was a group endeavour. It is not uncommon Lymphocytes: 20 - 40% or 1,000 to 4,800 cells/mm³. - The increase in minute ventilation leads to a normal hyperventilation of pregnancy, which in turns leads to a mild chronic respiratory alkalosis with a compensatory metabolic acidosis. Labor. Explain how many of each is present in a gamete and in a somatic cell. Current pregnancy symptoms Underweight 28-40 lb. High-Risk Conditions and Complications During Pregnancy 49 4. category Z34, Encounter for supervision of normal pregnancy, should be used as the first - listed diagnosis. Postcode First name Surname D M YD M YD M Y These notes should be carried by the expectant mother at all times during her pregnancy. Notes Pregnancy NHS No. Pregnancy usually occurs by sexual intercourse, but can also occur through assisted reproductive technology procedures. The huge increase in weight is achieved by hypertrophy, not hyperplasia of the myometrial cells.The hypertrophy occurs up to 20 weeks after conception, after that the increase in uterus size is purely stretching from the fetus and surrounding fluid. WHAT IS PUERPERIUM? • Key Concepts, cont'd • Through the food a pregnant woman eats, she gives her unborn child the This however is not a paper where we APGAR Scoring: Appearance, Pulses, Grimace, Activity, Reflex Irritability. Begins as soon as placenta is expelled lasts for appx 6 weeks(42 days) 3 stages I. Immediate-within 24hrs II. MANAGEMENT OF NORMAL LABOUR AND DELIVERY Dr Nabeel Bondagji Consultant Perinatologist KAUH&KFSH LECTURE OVERVIEW Definitions Anatomy of the fetal head and maternal pelvis Management of 1st, 2nd and 3rd stages of normal labour monitoring of maternal well being monitoring of fetal well-being monitoring progress of labour NORMAL LABOUR: Definitions Onset of regular involuntary coordinated . Let us study about prenatal development. Done at 1 and 5 minutes with a score of 0 for Normal Pregnancy 23 3. count as pregnancy progresses, with 7.6% of women having a count less than 150,000 and 1% less than 100,000 at term.5 Endogenous anticoagulants, such as protein S, are decreased in normal pregnancy and there is acquired resistance to acti-vated protein C during pregnancy, adding to the prothrombotic state. Second and subsequent labours last on average 5 hours and are unlikely to last over 12 hours. In case of abnormal uterine . At the end of the first postpartum week, it normally will have decreased to the size of a 12-week gestation and is palpable at the symphysis pubis (Fig. . to 25,000 can be normal for labor, birth, and early pp (d/t . Reproductive system Cardio vascular system Respiratory system Urinary system Gastro intestinal system Metabolic changes Skeletal changes Skin changes Endocrine system[changes of endocrine and role of endocrine system in relation to reproduction] Lecture The course is designed to be evidence-based, family-centred and The phases of pregnancy from preconception to postnatal care; Maternal medicine and fetal medicine; Menstruation; Infertility; Urogynaecology; Gynaecologic oncology; Designed for trainees and to support experienced practitioners, Dewhurst's Textbook of Obstetrics & Gynaecology is your ideal clinical companion. Viability @ 24 . Prenatal outpatient visits for high-risk patients • For routine prenatal outpatient visits for patients with high-risk pregnancies, a code from Temperature Normal Labor and Delivery. • Pregnancy. pregnancy normal appearance and measurements used for dating • This is NOT intended to cover all Ob Gyne pathology ©AIUM US terminology Isoechoic- Same brightness as surrounding soft tissue structures . Cervical Effacement and Dilatation; The Mechanism of Normal Labor The definition or clinical diagnosis of labor is a retrospective one. Pregnancy Your Weight Gain Goal Normal 25-35 lb. Women who are high-risk or present with abdominal pain or vaginal bleeding in early gestation are more likely to be evaluated by US and additional hormonal assays. Gestational age is the number of weeks that have passed since the first day of a woman's last normal menstrual period. pregnancy. Notes 8.1 DEVELOPMENT OF CHILDREN DURING PRENATAL STAGE The average period of human pregnancy is 37 weeks to 41weeks. Z34.93* Encounter for supervision of normal pregnancy, unspecified, third trimester Supervision of Normal Pregnancy (ICD-9-CM V22.0, V22.1, V22.2) *Codes with a greater degree of specificity should be considered first. • Abdominal or vaginal examination to note the position of the baby, the station of the presenting part, and the dilatation of the cervix dr.Shaban . It is important to note as well that, because common symptoms of depression overlap considerably with those of normal pregnancy and postpartum periods (e.g., changes in appetite, sleep patterns, and libido), perinatal depression often goes unrecognized. • Drug abuse. Thus, a full-term pregnancy would be 40 weeks long. This chapter describes the OB/GYN: Shelf Review Notes Table of Contents Obstetrics.2 Normal pregnancy / Prenatal care.2 Early 5- Reference ranges: Normal values ranges for the specific period of pregnancy episode, e.g. Zinc in Human Nutrition And Health . PRENATAL SOAP NOTE Student Name Date of Clinic Visit Patient's Name Preceptor's Name S (SUBJECTIVE) Information related to the physician from the patient directly. Adjustment for body surface area is necessary when comparing a patient's Pregnancy (gestation) is the physiologic process of a developing fetus within the maternal body. Gestational sac on transvag U/S @ b-hCG of 1500-2000 (5wks) Fetal heart @ b-hCG of 5-6000 (6wks) TPAL: remember abortus = < 20 wk losses (TAB/SAB/ectopic) Dates & stuff 0-8wks = embryo, 8wks-birth = fetus. -For postpartum patients, include vital signs, general/psych (normal affect, NAD), CV, Resp, ABD including where her fundus is (usually at umbilicus), perineal exam and breasts Eosinophils: 1 - 4% or 0.0 to 450 cells/mm³. Maternal blood loss should be replaced to hematocrit within normal limits in pregnancy Rh immune globulin should be given when isoimmunization is a concern (i.e. Denied pregnancy. Normal Puerperium 1. In the first stage Micturation--- descent of the fetus causes the bladder to care and modern principles and practices of sound care in pregnancy, labour and birth and the postpartum period, through better case management and appropriate interventions, while maintaining safety. Obstetrics Normal pregnancy / Prenatal care Urine preg test: positive around time of missed cycle. Normally, pregnancy brings about a slight decrease in the woman's blood pressure. New OB prenatal visit Routine prenatal care follow-up visit Conduct, record and present OB patient history 3. Vital Signs were within normal limits. day 2, and returns to normal by 1 week WBC is commonly elevated during labor and begins to decline PP (WBC of 20,000-25,000 common) Clinical Punchline •Hgb, Hct, and WBC values are not reliably reflective of anemia or infection in the first days Nichol B 1997, Parlow DB 2004 Figure 9.3: Measurement of amniotic fluid using the Amniotic Fluid Index (AFI) technique in a pregnancy with normal fluid. ±2 days in the same woman, as a normal pa ern, what is described as a regular cycle. pregnancy, some changes in maternal physiology can occur including increased maternal fat, blood volume, cardiac output, and blood flow to the kidneys and uteroplacental unit, decreased blood . • Dipstick analysis: Tests include pH, specific gravity, protein, glucose, ketones, nitrite, and leukocyte esterase. is defined as the process by which the fetus is . 2. in a vertical line measurement (normal here at 5.5 cm). Exactly what causes labor to start is unknown. Normal ranges 1 First labours last on average 8 hours and are unlikely to last over 18 hours. Overweight 15-20 lb. • Define the terms karyotype, autosomal and sex chromosomes. Complications During the Neonatal Period: The High-Risk Newborn 191 . Sarah Kilpatrick and Etoi Garrison. •Return to normal size - up to 6 months post-pregnancy. Human Anatomy & Physiology: Blood & Hematology; Ziser Lecture Notes, 2005 13 Rh incompatability: mother is Rh - & fetus is Rh + no reaction if normal pregnancy second such pregnancy antibodies cross placenta RhoGAM blocks the mothers immune systems response and prevents her sensitization to Rh+ blood of child. Labor usually starts within 2 weeks of (before or after) the estimated date of delivery. The Newborn Infant 173 9. This is a very exciting time in your life. Maternity Unit Date of birth Address Unit No. The higher cardiac output is due to an increase in blood volume, body weight, and increased metabolism during normal pregnancy. 0 to 12-14 wks = 1st tri, 12-14 to 24-28 = 2nd tri, > 24-28 wks = 3rd tri. Note the measurements in four quadrants of the uterine (Q) cavity. PREGNANCY FACTS • A normal pregnancy lasts about 40 weeks and is grouped into three trimester F • Symptoms of early pregnancy include the absence of menstrual period, breast changes, tiredness, nausea, mood swings or other A symptoms C • A pregnancy test measures the hormones human chorionic gonadotropin in the urine or blood. The basic biology of the menstrual cycle is a complex, coordinated sequence of events involving the hypothalamus, anterior pituitary, ovary, and endometrium. The Department of Health would like to thank all those involved in shaping the updated edition of The Pregnancy Book, including the mothers and fathers, medical and health professionals, and the MID 11 pathogenicity. . Thank you and wish you happy and fruitful . KEY MESSAGES OF LESSON: 1) Pregnancy begins when a fertilized egg implants in the uterus. Author order does not indicate . pregnancy, to the embryo with cardiac activity. Complications During the Postpartal Period 159 8. Presentation/Notes: Postpartum For example (Exam): Ms. X is a 24 year old Gravida 2 Para 2 who is postpartum day #1 status post vaginal delivery. Maternity Normal Values Fetal Heart Rate: 120—160 bpm Variability: 6—10 bpm Amniotic fluid: 500—1200 ml Contractions: 2—5 minutes apart with duration of < 90 seconds and intensity of <100 mmHg. Kidney function is proportional to kidney size, which is proportional to body surface area. Gabbe et al., Obstetrics: Normal and Problem Pregnancies, 2017 www.nlm.nih.gov Note that the pocket is free of cord and fetal parts and is at least 1 cm in width. Peripheral oedema: may be a normal finding in late pregnancy, but if widespread consider pre-eclampsia. This note covers the following topics: Female reproductive tract anatomy, Male reproductive tract anatomy, Female anatomy, follicular aspiration, Embryogenesis of the pituitary gland, Reproductive cycles in the female, Luteal phase of the estrous cycle and the menstrual cycle, Sexual behavior, Pregnancy and fetal development, Reproduction of humans. in severe abdominal cramping thought due to sister's cooking. It is also important to note that maternal or . Figure 1. 2. However, as the pregnancy progresses, certain common-sense rules and pregnancy work restrictions certainly apply. OB nurse reported fundus firm, at midline, one finger above umbilicus. Nose and mouth bulb suctioned at perineum; body delivered without difficulty. calculate the length of a pregnancy by gestational age. Describe common problems in obstetrics. The information in this guide can help you make your best choices to be well. Normal lab values for white blood cell count and WBC differential: WBC Count: 4,500 to 11,000 cells/mm³. WHAT IS PUERPERIUM? And we're here to help keep you and your baby healthy. •Maternal BP decreases early in pregnancy, reaches a nadir mid-pregnancy and returns to pre-pregnancy levels by term. A pregnancy is diagnosed as high risk . Aim for gaining ½ - 1 lb per week after your first trimester. Begins as soon as placenta is expelled lasts for appx 6 weeks(42 days) 3 stages I. Immediate-within 24hrs II. ANTENATAL COMPLICATIONS, NORMAL LABOUR AND DELIVERY; ABNORMAL LABOUR, OPERATIVE OBSTETRICS; OBSTETRICAL ANESTHESIA, NORMAL PUERPERIUM; PUERPERAL COMPLICATIONS, DRUGS CONTRAINDICATED IN PREGNANCY; The PDF version of the Obstetrics notes is attached for free and easy download at the bottom of this thread. Among Gram positive organisms, in contrast, Staphylococcus aureus uncommonly causes cystitis and ascending pyelonephritis, whereas Staphylococcus saprophyticus, which adheres significantly better to uroepithelium than do Staphylococcus aureus or Staphylococcus epidermidis, is a frequent cause of lower urinary tract infections. The menstrual cycle with all its complexities can be easily perturbed by environmental factors such as stress, extreme exercise, eating . deficiency leads to complications of pregnancy and childbirth, lower birth weight and poor growth in childhood, reduced immune- Jayant Deshpande et al. Zinc is found in the vesicles of the mossy fiber system of the brain's . When to use the maternity early warning scoring system MEOWS assessments must be undertaken and documented, regardless of location, on initial assessment and thereafter 12 hourly or as indicated by the score, for: Because the expansion in plasma volume is greater than the increase in red blood cell mass, there is a fall in haemoglobin concentration, haematocrit and red blood cell count. • Microscopic analysis: Sediment is examined for red blood cells, white Health Insurance- IA, KS, MN, MO, ND, NE, OK, SD, WI- Medica Rh neg patients). Note: no upper limit to the latent phase of labour can be defined. Explain the normal physiologic changes of pregnancy including interpretation of common diagnostic studies. 10-1). In general, pregnancy should not restrict someone from normal activity. Descent of the presenting part of the fetus into the birth canal, particularly in a first pregnancy, is another result of pre-labor. LABOR: DEFINITION AND PHYSIOLOGY. If pre-eclampsia is suspected, you should check the patient's blood pressure and perform urinalysis (looking for proteinuria). NORMAL PUERPERIUM 2. Neutrophils: 55 - 70% or 1,800 to 7,800 cells/mm³. A body surface area of 1.73 m2 is the normal mean value for young adults. delivery, preferably by c-section, if pregnancy is equal to or over 37 wks gestations. These include: First trimester (from conception through 13 weeks): Allowance to adequately hydrate on a regular basis and provide the employee/patient time off to drink and use the restroom as needed. human chorionic gonadotropin in urine to aid in the early detection of pregnancy. Palmar erythema: a redness involving the heel of the palm that is a normal finding in pregnancy. and. 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